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Vashist P, Grover S, Manna S, Senjam SS, Gupta V, Gupta N, Bhardwaj A. Rapid survey for assessing effective cataract surgical coverage (eCSC) and effective refractive error coverage (eREC)-Novel indicators of universal eye health. Indian J Ophthalmol 2024; 72:1321-1328. [PMID: 38767538 DOI: 10.4103/ijo.ijo_1668_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE As per the recent World Health Organization estimates, approximately 2.2 billion people have near and distance vision impairment (VI) globally, and out of this almost 50% is avoidable. METHODS The Rapid Assessment of Avoidable Visual Impairment survey was a cross-sectional study conducted in September 2021, using cluster random sampling in 42 clusters with a cluster size of 140, giving a total of 6000 participants. Two teams comprising of trained optometrists and social workers conducted the ocular examination which included unaided, pinhole, and aided visual acuity assessments followed by examination of the anterior segment and lens. Distance visual acuity was measured using simplified tumbling "E" charts of different sizes for VA of 6/12, 6/18, and 6/60. The lens assessment was done in an un-dilated pupil with torch light by the optometrist. RESULTS Overall, 6520 individuals aged 6 years and above were enumerated, of whom 5440 (83.4%) were examined. The response rate for examination was better among females (93.1%) than males (73.9%), and it decreased from 93.8% in the age group 6-15 years to 77.1% in the 45+ age group. The prevalence of blindness and VI were 0.18% (95% CI: 0.06-0.29) and 4.19% (95%CI: 3.65-4.72), respectively. The major causes of VI in all age groups were uncorrected refractive error (65.4%), cataract (23.7%), cataract surgical complications (2.6%), corneal opacity (0.4%), and other posterior segment diseases (7.5%). The effective cataract surgical coverage (eCSC) was 61.8%, effective refractive error coverage (eREC) for distance vision was 59.8%, and eREC for near vision was 47.0%. CONCLUSION The RAAVI methodology is suitable to measure effective coverage in the general population, both for baseline measurement and periodic monitoring. The 2030 targets for the surveyed district are 90% eCSC and 100% eREC. Such exercises need to be conducted in each district of the country to determine the baseline and target values of effective coverage.
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Affiliation(s)
- Praveen Vashist
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Sumit Grover
- Department of Ophthalmology, National Cancer Institute, AIIMS, New Delhi, India
| | | | - Suraj S Senjam
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Vivek Gupta
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Noopur Gupta
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Amit Bhardwaj
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Kumar H, Pant H, Chaudhuri S, Kalluri V, Sarvepally VK, Govindahari V, Vashist P, Tandon R, Murthy GVS. Prevalence of blindness and visual impairment in a coastal region of Southern India: A cross-sectional survey in Prakasam district, Andhra Pradesh. Indian J Ophthalmol 2024; 72:994-1000. [PMID: 38454844 PMCID: PMC11329806 DOI: 10.4103/ijo.ijo_2785_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To estimate the magnitude, determinants, and causes of visual impairment (VI) and blindness among people >40 years. METHODS In this cross-sectional survey, 2,968 people >40 years from 34 clusters were examined. A cluster random sampling method with a compact segment sampling technique was used to select the study participants. Prevalence of any VI (presenting visual acuity (PVA) <6/12 in better eye), severe VI (PVA <6/60 - 3/60), and blindness (PVA <3/60 in better eye) were expressed as percentage with 95% confidence interval. Logistic regression was performed to determine the risk factors associated with blindness. A P value of less than 0.05 was considered statistically significant. RESULTS The mean age of the participants was 54.6 years (Standard deviation ± 11.2 years). The prevalence of mild, moderate, and severe visual impairment was 14.2% (12.95-15.49), 13.7% (12.46-14.97), and 0.7% (0.47-1.12), respectively. The prevalence of blindness was 1.3% (0.94-1.79, n = 39). The overall prevalence of VI (presenting Visual Acuity <6/12) was 12.0% (95% CI: 10.8-13.2%). The major causes of VI were cataract (78.08%), refractive error (12.07%), and optic atrophy (2.22%), and corneal opacity (2.22%) and the major cause of blindness was cataract (77.27%). Blindness was strongly associated with increasing age- OR 17.1 (95% CI: 4.9-59.8) for people >70 years, and OR 7.6 (95% CI: 2.2-26.5) for people aged between 60 and 69 years compared to those aged 41-50 years and people living near coastal regions (Within 50 km of coast) (OR: 3.9, 95% CI: 1.6-7.3). CONCLUSION Blindness and vision impairment are of public health concern in this geographic region. Eye care services need to be augmented to address this challenge.
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Affiliation(s)
- Hemanth Kumar
- Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Hira Pant
- Indian Institute of Public Health, Hyderabad, Telangana, India
| | | | - Viswanath Kalluri
- Department of Vitreo-Retinal Services, Pushpagiri Vitreo Retina Institute, Secunderabad, India
| | - Vijay Kiran Sarvepally
- Department of Vitreo-Retinal Services, Pushpagiri Vitreo Retina Institute, Secunderabad, India
| | - Vishal Govindahari
- Department of Vitreo-Retinal Services, Pushpagiri Vitreo Retina Institute, Secunderabad, India
| | - Praveen Vashist
- Community Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Radhika Tandon
- Community Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - GVS Murthy
- Indian Institute of Public Health, Hyderabad, Telangana, India
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Gupta S, Vardhan A, Ambalam V, Rajendran V, Joseph S, Ravilla TD. Cataract surgery workload estimates in Theni district, India. Br J Ophthalmol 2024; 108:915-920. [PMID: 37673466 PMCID: PMC11228226 DOI: 10.1136/bjo-2023-323182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/29/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND/AIMS To estimate the annual cataract surgery workload in Theni district, Tamil Nadu, India based on current utilisation of cataract services, prevalence of blindness and vision impairment (VI), and cataract burden-reduction goals. METHODS We conducted a population-based longitudinal study between January 2016 and April 2018. We recruited 24 327 participants based on a random cluster sampling method; 7127 participants were ≥40 years. During the year following initial enrolment, we tracked utilisation of eye care services; and at the end of the 1-year period, we conducted a detailed eye examination of participants age ≥40. RESULTS In the sample age ≥40 years, 13.0% had a visually significant cataract, and 17.8% had prior cataract surgery in at least one eye. The prevalence of cataract blindness based on presenting visual acuity in the better eye (PVABE)<3/60 was 0.34% and VI (PVABE<6/12) was 9.92%. 3.10% of the study population had obtained cataract surgery during 1 year, resulting in a cataract surgical rate of 9085. We estimated the effective cataract surgical coverage (eCSC) to be 54.5% and the CSC to be 75.7%, implying a sizeable quality gap. Prevalence, utilisation and coverage varied by age and gender. We estimated that a goal of eliminating the backlog of VI (PVABE<6/12) in 5 years would increase the annual cataract surgery workload by 11.5% from the current level. CONCLUSIONS Our estimates of cataract surgery workloads under different scenarios can provide a useful input into planning of eye health services in Theni district.
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Affiliation(s)
- Sachin Gupta
- Cornell University SC Johnson College of Business, Ithaca, New York, USA
| | - Ashok Vardhan
- Aravind Eye Hospital, Tirupati, Andhra Pradesh, India
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Chadalavada HP, Marmamula S, Khanna RC. Vision impairment and access to eye care in an integrated network of eye care system in Southern and Eastern India. Indian J Ophthalmol 2024; 72:264-269. [PMID: 38099374 PMCID: PMC10941943 DOI: 10.4103/ijo.ijo_1043_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE The World Report on Vision highlights that health information systems (HIS) should collect information on the determinants of eye conditions and vision impairment (VI) as a step toward integrated people-centered eye care (IPEC). Thus, this retrospective study aims to elucidate VI trends across age and gender of the patients who visited our centres in southern and eastern India. METHODS Electronic medical records of all new patients who visited the network were included. VI was defined as visual acuity less than 6/12; unilateral VI was based on the worse presenting eye (the other eye being normal), and bilateral VI was based on the better eye. "Total VI" includes both unilateral and bilateral VI. RESULTS The records of 7,31,307 patients from January to December 2019 were extracted. Males were 54%. The mean age was 40 years (SD: 19.16 years). The majority of patients (46.54%) visited a primary care centre. Centres in Andhra Pradesh saw the largest number of patients (46%). Approximately 65% of all patients presented had no VI in either eye. Total VI was 23.5% at the primary-centre level and approximately 45% at other levels, the highest being in Odisha. More females accessed care at primary and secondary centres (46.6%) than at higher levels of care (44%). Odisha had the lowest number of females accessing care (43.01%). CONCLUSION Non-visually impairing conditions form an important reason for patients visiting our eye care facilities. Strategies focusing on improving access to eye care for females should be planned at all levels, especially in Odisha.
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Affiliation(s)
- Harithaa P Chadalavada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- DBT Wellcome India Alliance, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Srivastava S, Kumar M, Muhammad T, Debnath P. Prevalence and predictors of vision impairment among older adults in India: evidence from LASI, 2017-18. BMC Ophthalmol 2023; 23:251. [PMID: 37277715 DOI: 10.1186/s12886-023-03009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/31/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Older adults experience a natural decline in health, physical and cognitive functionality, and vision impairment (VI) is one among them and has become an increasing health concern worldwide. The present study assessed the association of chronic morbidities such as diabetes, hypertension, stroke, heart diseases and various socioeconomic factors with VI among older Indian adults. METHODS Data for this study were derived from the nationally-representative Longitudinal Ageing Study in India (LASI), wave-1 (2017-18). VI was assessed using the cut-off of visual acuity worse than 20/80, and additional analysis was carried out using the definition of VI with a cut-off of visual acuity worse than 20/63. Descriptive statistics along with cross-tabulation were presented in the study. Proportion test was used to evaluate the significance level for sex differentials in VI among older adults. Additionally, multivariable logistic regression analysis was conducted to explore the factors associated with VI among older adults. RESULTS About 33.8% of males and 40% of females suffered from VI in India (visual acuity worse than 20/80). Meghalaya (59.5%) had the highest prevalence for VI among older males followed by Arunachal Pradesh (58.4%) and Tripura (45.2%). Additionally, Arunachal Pradesh (77.4%) had the highest prevalence for VI among females followed by Meghalaya (68.8%) and Delhi (56.1%). Among the health factors, stroke [AOR: 1.20; CI: 1.03-1.53] and hypertension [AOR: 1.12; CI: 1.01-1.22] were the significant risk factors for VI among older adults. Additionally, being oldest old [AOR: 1.58; CI: 1.32-1.89] and divorced/separated/deserted/others [AOR: 1.42; CI: 1.08-1.87] were significantly associated with VI. Moreover, older adults with higher educational status [AOR: 0.42; CI: 0.34, 0.52], currently working [AOR: 0.77; CI: 0.67, 0.88], from urban areas [AOR: 0.86; CI: 0.76-0.98] and from western region [AOR: 0.55; CI: 0.48-0.64] had lower odds of VI in this study. CONCLUSION This study identified higher rates of VI among those who are diagnosed with hypertension or stroke, currently unmarried, socioeconomically poorer, less educated and urban resident older people that can inform strategies to engage high risk groups. The findings also suggest that specific interventions that promote active aging are required for those who are socioeconomically disadvantaged as well as visually impaired.
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Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Manish Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
| | - Paramita Debnath
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
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Kapatamoyo E, Sialubanje C, Muma KIM, Syakantu G, Minnies D. Availability of refractive error correction services in selected Zambian hospitals: a cross-sectional quantitative study. BMJ Open 2023; 13:e070297. [PMID: 36828649 PMCID: PMC9972430 DOI: 10.1136/bmjopen-2022-070297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE To assess the availability of refractive error correction services (RECS) in selected Zambian hospitals. METHODS Between October 2021 and March 2022, we conducted a cross-sectional study design among 20 eye health service providers selected from 20 public health facilities offering RECS in 20 districts from 8 provinces of Zambia. A stratified random sampling technique was used to select study participants. A questionnaire was developed based on the access to healthcare services framework and distributed via email to respondents to collect their perspectives on the availability of RECS. RESULTS All 20 respondents returned the completed questionnaires. Most facilities met the Ministry of Health recommended equipment requirement, though tonometers were lacking in some facilities. Out of the 20 facilities, 75% reported having optometry technologists as the main staff offering eye health services; 10% had an ophthalmologist; no facility had an optometrist; none conducted school-based programmes and only 1 facility (5%) was able to dispense spectacles soon after refraction because it had a spectacle manufacturing workshop. CONCLUSION These findings show limited availability of RECS in the 20 health facilities. They also confirm that challenges in staffing levels, insufficient equipment and low rate of spectacle dispensing negatively affect availability of these services. Furthermore, insufficient infrastructure undermines service delivery. Addressing these challenges is cardinal to improving RECS delivery and enhancing universal eye healthcare coverage in Zambia.
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Affiliation(s)
- Esnart Kapatamoyo
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
- Faculty of Health Sciences, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Cephas Sialubanje
- School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Kangwa I M Muma
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
- Eye Hospital, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Gardner Syakantu
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Deon Minnies
- Faculty of Health Sciences, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
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Ehrlich JR, Agarwal A, Young C, Lee J, Bloom DE. The prevalence of vision impairment and blindness among older adults in India: findings from the Longitudinal Ageing Study in India. NATURE AGING 2022; 2:1000-1007. [PMID: 37118083 PMCID: PMC10148950 DOI: 10.1038/s43587-022-00298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/23/2022] [Indexed: 04/30/2023]
Abstract
Vision impairment and blindness are strongly associated with aging and late-life disability. While home to about 17% of the world's population, an estimated 25% of visually impaired people globally live in India. This proportion is expected to increase as India's population rapidly ages and continues to grow. There is a need for up-to-date epidemiologic data on the prevalence of vision impairment and blindness in India and on the socioeconomic determinants of poor vision, especially among older adults, to promote visual and overall health and well-being in later life. This paper uses newly available data from Wave 1 (2017-2019) of the population-based Longitudinal Ageing Study in India to estimate the overall and sex-specific prevalence of presenting visual acuity impairment and blindness among individuals aged 45 and older at the national level and for all constituent states and union territories. Overall, 33.8% (95% confidence interval: 33.31%, 34.26%) of the Indian population aged 45 and older had distance visual acuity impairment or was blind (visual acuity in the better-seeing eye < 20/40). The age-standardized prevalence varied considerably among states (22.3-54.6%), and women were more likely than men to be visually impaired or blind in all states. Near visual acuity impairment was also highly prevalent (43.0%, 95% confidence interval: 42.45%, 43.46%). Vision impairment and blindness were more common among marginalized groups and were associated with lower socioeconomic status. Findings from this study are relevant for surveillance of vision health, design of targeted eye care policies and programs and efforts to promote human and economic development.
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Affiliation(s)
- Joshua R Ehrlich
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Arunika Agarwal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Codi Young
- Center for Economic & Social Research, University of Southern California, Los Angeles, CA, USA
| | - Jinkook Lee
- Center for Economic & Social Research, University of Southern California, Los Angeles, CA, USA
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - David E Bloom
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Blindness and visual impairment and their causes in India: Results of a nationally representative survey. PLoS One 2022; 17:e0271736. [PMID: 35862402 PMCID: PMC9302795 DOI: 10.1371/journal.pone.0271736] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Avoidable blindness is a significant public health problem in India. Nationally representative RAAB surveys (Rapid Assessment of Avoidable Blindness) are being conducted periodically in the country to know the current status of blindness in the country. The current study describes the findings from the RAAB survey conducted during 2015–19 in India.
Methodology
A cross-sectional, population-based survey was conducted across the entire country among persons aged 50 years and above using RAAB version 6 methodology. Presenting and pinhole visual acuity was recorded followed by lens examination using a torchlight. In order to estimate the prevalence of blindness and visual impairment in overall population in India, district weights were assigned to each of the 31 surveyed districts and the prevalence was standardized using the RAAB software.
Results
The overall weighted, age-gender standardized, prevalence of blindness (presenting visual acuity <3/60 in better eye) in population aged ≥50 years was 1.99% (95% CI 1.94%, 2.13%) and of visual impairment (VI) (presenting visual acuity <6/12 in better eye) was 26.68% (95% CI 26.57–27.17%). On multivariate analysis, adjusted odds ratio showed that blindness was associated with age ≥ 80 years (OR = 20.3, 95% CI: 15.6–26.4) and being illiterate (OR = 5.6, 95% CI: 3.6–8.9). Blindness was not found to be significantly associated with either gender or locality.
Conclusion
The results of the survey demonstrate that currently more than one fourth of persons aged 50 years and above are visually impaired (PVA<6/12 in better eye) in India. The prevalence of blindness among them is 1.99%, and older age and illiteracy are significantly associated with blindness. Major causes of blindness included cataract (66.2%), corneal opacity (CO) (8.2%), cataract surgical complications (7.2%), posterior segment disorders (5.9%) and glaucoma (5.5%). The proportion of blindness and visual impairment that is due to avoidable causes include 92.9% and 97.4% respectively.
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Cao H, Cao X, Cao Z, Zhang L, Han Y, Guo C. The prevalence and causes of pediatric uncorrected refractive error: Pooled data from population studies for Global Burden of Disease (GBD) sub-regions. PLoS One 2022; 17:e0268800. [PMID: 35776717 PMCID: PMC9249246 DOI: 10.1371/journal.pone.0268800] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are limited systematic reviews on the prevalence of uncorrected refractive errors in children. We aimed to summarize the prevalence and causes of pediatric uncorrected refractive error (URE) from studies in the Global Burden of Disease (GBD) sub-regions. METHODS The pooled analysis used the individual participant data (ages less than 20 years old) from population-based studies around the world by regions. URE was defined as presenting VA < 6/18 and improving to ≥ 6/18 or ≥1 line on using a pinhole in either eye, with main causes of myopia, hyperopia or astigmatism. Each study provided data on any URE, myopia, hyperopia or astigmatism by age, gender, and ethnicity. Prevalence rates were directly age and gender standardized to the 2020 world population with all age groups. Estimates were calculated by study and sub-regions after pooling. Summary estimates included studies in which URE was assessed from a pinhole-corrected refraction in the better eye. RESULTS The combined pooled data contained 302,513,219 patients including 8 963 URE cases individuals from 57 studies. Prevalence varied by age and GBD sub-regions and differed by gender. The age- and region-standardized prevalence of URE was 3.41 per 1000 (CI, 1.53~7.62) in Western Pacific region (12 studies), 2.26 per 1000 (CI, 0.85~6.01) in South-East Asia region (14 studies), 5.85 per 1000 (CI, 3.75~9.13) in Americans (11 studies) and 4.40 per 1000 (CI, 3.0~6.45) in Eastern Mediterranean region (13 studies). On the basis of these data, myopia was the first-leading cause in female children with 12~17 age group, with the prevalence rate 18.2 per 1000 (CI, 11.52~23.61). Astigmatism was detected in 27.2 per 1000 male children with 6~11 age group (CI: 19.12-30.68). CONCLUSIONS Prevalence of URE available data within these sub-regions are widely disparate. Myopia and astigmatism in young age children continue as the leading cause of URE worldwide. Providing appropriate refractive correction to those individuals whose vision can be improved is an important public health endeavor with implications for safety and quality of life.
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Affiliation(s)
- He Cao
- Department of Ophthalmology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong Province, People’s Republic of China
| | - Xiang Cao
- Emergency Department, The First Affiliated Hospital of Jiamusi University, Heilongjiang Province, People’s Republic of China
| | - Zhi Cao
- VPL Department, Mentor Graphics Technology (Shenzhen) CO. LTD., Guangdong Province, People’s Republic of China
| | - Lu Zhang
- Department of Ophthalmology, No. 4 Hospital of Xi’an City, Xi’an, Shanxi Province, People’s Republic of China
| | - Yue Han
- Nangang Branch, The Second Hospital of Heilong jiang Province, Harbin City, Heilongjiang Province, People’s Republic of China
| | - Changchun Guo
- Pingshan District People’s Hospital of Shenzhen, Shenzhen, Guangdong Province, People’s Republic of China
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Sharma N, Sharma C. Female gender: A significant barrier to access cataract surgery in rural Gurugram, Haryana, India. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2022. [DOI: 10.1177/02646196221085848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal of this study is to determine whether the female gender is a barrier for the access to cataract surgery in the rural population of Gurugram district, Haryana, India. The data of consecutive 100 male and 100 female patients operated for cataract surgery at Department of Ophthalmology, University-affiliated hospital were studied. Data pertaining to age of the patients, visual acuity of the operated and better eye, maturity of the cataract at time of surgery, type of cataract surgery opted were analysed. Visual impairment was considered when visual acuity of the better eye was less than 6/18 (0.32).Two types of cataract surgery were offered to the patients: manual small-incision cataract surgery (SICS) and phacoemulsification. Independent t-tailed test was used to analyse data to ascertain female gender as a barrier to access cataract surgery. The findings indicate that the difference in age at the time of surgery between men and women was not statistically significant ( p = .327). The analysis of visual impairment in the operated eye of men and women was also not statistically significant ( p = .173). However, the analysis of visual impairment in the better eye was strongly suggestive of gender bias with statistically significant results ( p = .001). In total, 71% male and 56% female patients opted for phacoemulsification surgery, whereas 44% women and 29% men chose less-expensive manual SICS surgery. The study indicates that females had severe visual impairment in the better eye at the time of surgery and also opted for a less-expensive option indicating less financial freedom and decision-making power.
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Malik M, Strang N, Campbell P, Jonuscheit S. Exploring eye care pathways, patient priorities and economics in Pakistan: A scoping review and expert consultation study with thematic analysis. Ophthalmic Physiol Opt 2022; 42:694-716. [PMID: 35318687 PMCID: PMC9310639 DOI: 10.1111/opo.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
Purpose As the prevalence of eye diseases increases, demand for effective, accessible and equitable eye care grows worldwide. This is especially true in lower and middle‐income countries, which have variable levels of infrastructure and economic resources to meet this increased demand. In the present study we aimed to review the literature on eye care in Pakistan comprehensively, with a particular focus on eye care pathways, patient priorities and economics. Methods A systematic scoping review was performed to identify literature relating to eye care in Pakistan. Searches of relevant electronic databases and grey literature were carried out. The results were analysed through a mixed methods approach encompassing descriptive numerical summary and thematic analysis. To consolidate results and define priority areas for future study, expert consultation exercises with key stakeholders were conducted using qualitative semi‐structured interviews. Results One hundred and thirty‐two papers (published and unpublished) were included in the final review. The majority (n = 93) of studies utilised a quantitative design. Seven interlinked themes were identified: eye care pathways, burden of eye disease, public views on eye‐related issues, workforce, barriers to uptake of eye care services, quality of eye care services and economic impact of blindness. Research priorities included investigating the eye care workforce, the quality and efficiency of current eye care services, eye care services available in rural Pakistan and the costs and benefits related to eye care provision and sustaining eye care programmes. Conclusions To the best of our knowledge, this is the first review to synthesise evidence from papers across the field relating to eye care in Pakistan. As such, this work provides new insights into the achievements of the national eye health programme, challenges in eye care in Pakistan and priority areas for future research.
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Affiliation(s)
- Manal Malik
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Sven Jonuscheit
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
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Danemayer J, Boggs D, Delgado Ramos V, Smith E, Kular A, Bhot W, Ramos-Barajas F, Polack S, Holloway C. Estimating need and coverage for five priority assistive products: a systematic review of global population-based research. BMJ Glob Health 2022; 7:bmjgh-2021-007662. [PMID: 35101862 PMCID: PMC8804659 DOI: 10.1136/bmjgh-2021-007662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/10/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION To improve access to assistive products (APs) globally, data must be available to inform evidence-based decision-making, policy development and evaluation, and market-shaping interventions. METHODS This systematic review was undertaken to identify studies presenting population-based estimates of need and coverage for five APs (hearing aids, limb prostheses, wheelchairs, glasses and personal digital assistants) grouped by four functional domains (hearing, mobility, vision and cognition). RESULTS Data including 656 AP access indicators were extracted from 207 studies, most of which (n=199, 96%) were cross-sectional, either collecting primary (n=167) or using secondary (n=32) data. There was considerable heterogeneity in assessment approaches used and how AP indicators were reported; over half (n=110) used a combination of clinical and self-reported assessment data. Of 35 studies reporting AP use out of all people with functional difficulty in the corresponding functional domains, the proportions ranged from 4.5% to 47.0% for hearing aids, from 0.9% to 17.6% for mobility devices, and from 0.1% to 86.6% for near and distance glasses. Studies reporting AP need indicators demonstrated >60% unmet need for each of the five APs in most settings. CONCLUSION Variation in definitions of indicators of AP access have likely led to overestimates/underestimates of need and coverage, particularly, where the relationship between functioning difficulty and the need for an AP is complex. This review demonstrates high unmet need for APs globally, due in part to disparate data across this sector, and emphasises the need to standardise AP data collection and reporting strategies to provide a comparable evidence base to improve access to APs.
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Affiliation(s)
- Jamie Danemayer
- Department of Computer Science, Global Disability Innovation Hub, University College London, London, UK
| | - Dorothy Boggs
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Emma Smith
- Department of Psychology, Assisted Living and Learning Institute, Maynooth University, Maynooth, Ireland
| | - Ariana Kular
- Department of Health Sciences, Mental Health and Wellbeing, University of Warwick, Warwick, UK
| | - William Bhot
- Department of Computer Science, Global Disability Innovation Hub, University College London, London, UK
| | - Felipe Ramos-Barajas
- Department of Computer Science, Global Disability Innovation Hub, University College London, London, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Cathy Holloway
- Department of Computer Science, Global Disability Innovation Hub, University College London, London, UK
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Dogra S, Sodani P, Raj D, Bhagat V. A comparative study of sodium bicarbonate and hyaluronidase on pain perception, anesthesia, and akinesia during peribulbar anesthesia for cataract surgery. Anesth Essays Res 2022; 16:31-35. [PMID: 36249141 PMCID: PMC9558670 DOI: 10.4103/aer.aer_128_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022] Open
Abstract
Background: An ideal anesthetic solution should provide good anesthesia and akinesia with minimal pain on injection. Aims: The aim of this study is to determine the effect on pain perception and efficacy of sodium bicarbonate over hyaluronidase in the local anesthetic mixture during peribulbar anesthesia. Settings and Design: A prospective, randomized, double-blind study. Materials and Methods: An independent observer labeled two injections as A (hyaluronidase 1500 IU in 30 mL of lignocaine) and B (7.5% sodium bicarbonate 1 mL in 30 mL of lignocaine). Group 1 was injected with injection A while Group 2 was injected with injection B. The visual analog scale (VAS) was used to determine the intensity of pain. Onset and degree of anesthesia and akinesia were recorded. Statistical Analysis: Computer software Microsoft Excel SPSS version 26 (Chicago Inc) for windows was used. The qualitative data and quantitative data were reported as proportions and mean ± (standard deviation), respectively. Chi-square test for proportions was used for the comparison of qualitative variables and unpaired Student's t-test was used to test the significance between quantitative variables. P < 0.05 was considered statistically significant. All P were two-tailed. Results: Out of 123 patients, 23 were excluded from the study. Hundred patients were divided into Group 1 and Group 2. The mean age in Group 1 was 64.92 ± 10.77 years while in Group 2 was 62.86 ± 11.17 years. The mean heart rate and mean systolic blood pressure in both groups were statistically insignificant. Group 2 experienced very less pain (mean pain score VAS = 5.12 ± 1.17) as compared to Group 1 (mean pain score was 7.16 ± 1.09) and the difference between both the groups was found to be statistically significant. There was a significant difference in the onset of anesthesia in both groups (P = 0.001). In the sodium bicarbonate group, the onset was faster. The onset of akinesia was better in Group 1 (4.76 ± 2.06 min). Grading of akinesia was better in Group 1. Conclusion: Sodium bicarbonate reduces pain on injection in peribulbar anesthesia and also results in a quicker onset of anesthesia.
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Adediran O, Oluleye T, Ayorinde O, Ugalahi M, Mpyet C. Survey of blindness in Saki East, Oyo State, Nigeria. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:41-47. [PMID: 36203926 PMCID: PMC9531733 DOI: 10.4103/jwas.jwas_65_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022]
Abstract
Background: Aim and Objectives: Materials and Methods: Results: Conclusion:
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Onyiaorah AA, Kizor-Akaraiwe NN, Nwosu SNN. Pattern of eye diseases in adults at the general outpatient clinic of a Tertiary Hospital in Nigeria. Ann Afr Med 2022; 21:421-425. [PMID: 36412345 PMCID: PMC9850897 DOI: 10.4103/aam.aam_152_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To determine the pattern of eye diseases at the general outpatient department (GOPD) of a Nigerian tertiary hospital. Materials and Methods Patients selected by systematic random sampling at the GOPD of a Nigerian tertiary hospital were studied. Information on sociodemographics and ocular complaints were obtained using interviewer-administered questionnaire. Ocular examination included visual acuity measurement and anterior and posterior segments examinations. Data analysis was with Statistical Package for the Social Sciences. Results Three hundred and eighty-two patients, comprising 124 (32.5%) males and 258 (67.5%) females, aged between 18 and 86 years, mean 44.8 ± 15.4 years, were studied; 112 (29.3%) had eye diseases but only 88 (78.6%) patients complained of ocular disorder(s). Common complaints were poor vision 53 (60.4%), red eye and grittiness 15 (17.0%) each. Common eye diseases were lens 52 (13.6%) and conjunctiva 46 (12.0%) disorders. Attaining higher education was protective against eye diseases (P < 0.05). Conclusion Nearly a third of patients at the GOPD have eye diseases. Therefore, primary eye care should be integrated into the GOPD service with provision of relevant manpower and facilities for care of the ophthalmic patients.
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Affiliation(s)
- Adaora Amaoge Onyiaorah
- Department of Ophthalmology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria,Department of Ophthalmology, Enugu State University of Science and Technology Teaching Hospital, Parklane, Enugu, Enugu State, Nigeria,Address for correspondence: Dr. Adaora Amaoge Onyiaorah, Department of Ophthalmology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria. E-mail:
| | - Nkiru N. Kizor-Akaraiwe
- Department of Ophthalmology, Enugu State University of Science and Technology Teaching Hospital, Parklane, Enugu, Enugu State, Nigeria
| | - Sebastian N. N. Nwosu
- Department of Ophthalmology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
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Bhardwaj RK. Information system for visually impaired in Indian universities: a user’s perspectives. INFORMATION DISCOVERY AND DELIVERY 2021. [DOI: 10.1108/idd-05-2021-0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to comprehend the perceptions of visually impaired users in development of information systems in Indian universities. This will help higher educational institutions in India to fulfil information requirements of visually impaired users.
Design/methodology/approach
A twofold method was used in the study: survey of visually impaired students in four universities; design and development of an online information system for visually impaired (ISVI). A structured questionnaire was used for survey of visually impaired users in Indian universities. The questionnaire with 33 open-ended questions was distributed among 603 visually impaired users and 316 responses were received. Stratified sampling technique was used in data collection. Response rate was 52.4%. The received responses were analysed using Statistical Package for Social Sciences version 19 and presented through tables and figures.
Findings
Majority of respondents revealed that lack of content availability in vernacular language, poor information resources access mechanism, less volume of course content and poor maintenance of assistive software(s) and devices and non-standardized e-resources compatible with the assistive software(s) are some major inhibits faced. Majority of respondents revealed that they prefer scribes in examinations because use of assistive technology (AT) is time-consuming. Lack of training and confidence in using AT is another reason for preferring scribes in examinations.
Research limitations/implications
This study was conducted on a limited number of visually impaired uses in Indian universities. Also, the online system ISVI contains a sample collection related to undergraduate courses only.
Practical implications
This study will help Indian universities to identify problems faced by visually impaired users. Findings of the study can help faculty members, decision-makers to understand the perspective of visually impaired. Besides this, the study can also help government agencies in formulating policies. Findings will help in developing robust information resources suiting the needs of visually impaired.
Originality/value
This study developed an online system ISVI (www.isvi.in) suitable to address the requirements of visually impaired students. Furthermore, it can guide policymakers, faculty members and information professionals in developing seamless open access information systems.
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Marmamula S, Yelagondula VK, Khanna RC, Banerjee S, Challa R, Yellapragada R, Keeffe JE. A Population-Based Cross-Sectional Study of Visual Impairment in West Godavari and Krishna Districts in Andhra Pradesh: Akividu Visual Impairment Study (AVIS). Ophthalmic Epidemiol 2021; 29:411-416. [PMID: 34294023 DOI: 10.1080/09286586.2021.1946829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the prevalence and causes of visual impairment (VI) among those aged ≥40 years in West Godavari and Krishna districts in Andhra Pradesh, India. METHODS Trained teams visited the households in the selected clusters and conducted eye examinations. Presenting visual acuity (PVA) was assessed for distance and near. Torchlight examination was conducted to assess the anterior segment. Non-mydriatic retinal images were also obtained. VI was defined as PVA worse than 6/18 in the better eye. It included Moderate VI (PVA worse than 6/18 to 6/60), Severe VI (PVA worse than 6/60 to 3/60) and Blindness (PVA worse than 3/60). Multiple logistic regression analysis was conducted to assess the risk factors for VI. RESULTS In total, 2587/3000 (86.2%) participants were examined. Of this, 1406 (54.4%) were women and 1224 (47.3%) had no education. The age- and gender-adjusted prevalence of VI was 12.8% (95% CI: 11.5-14.1). Compared to the 40-49-year age group, the odds of having VI among those aged 50-59 years, 60-69 years and ≥70 years were 2.93 (95% CI: 1.91-4.52), 6.53 (95% CI: 4.31-9.91) and 17.45 (95% CI: 11.50-26.46), respectively. Those respondents who had no education had a higher odds (OR: 1.73; 95% CI: 1.34-2.23) of VI compared to those who were educated. Cataract (62.4%) and uncorrected refractive errors (29.8%) were the leading causes of VI. Over 90% of the VI was due to avoidable causes. CONCLUSION VI is a major public health challenge in Andhra Pradesh. Over 90% of this burden is avoidable and can be eliminated by low-cost interventions such as spectacles and cataract surgery.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Vijay Kumar Yelagondula
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Saptak Banerjee
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Jill E Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
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Maseko SN, van Staden D, Mhlongo EM. The Rising Burden of Diabetes-Related Blindness: A Case for Integration of Primary Eye Care into Primary Health Care in Eswatini. Healthcare (Basel) 2021; 9:835. [PMID: 34356213 PMCID: PMC8307827 DOI: 10.3390/healthcare9070835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
There is a rampant increase in diabetes prevalence globally. Sub-Saharan Africa (SSA) is projected to carry the largest burden of diabetes (34.2 million) by 2030. This will inevitably cause a parallel increase in diabetes-associated complications; with the predominant complications being blindness due to diabetic retinopathy and diabetic cataracts. Eye programs in developing countries remain inadequate, existing as stand-alone programs, focused on the provision of acute symptomatic care at secondary and tertiary health levels. Over 60% of people with undiagnosed diabetes report to eye care facilities with already advanced retinopathy. While vision loss due to cataracts is reversible, loss of vision from diabetic retinopathy is irreversible. Developing countries have in the last two decades been significantly impacted by infectious pandemics; with SSA countries committing over 80% of their health budgets towards infectious diseases. Consequently, non-communicable diseases and eye health have been neglected. This paper aimed to highlight the importance of strengthening primary health care services to prevent diabetes-related blindness. In SSA, where economies are strained by infectious disease, the projected rise in diabetes prevalence calls for an urgent need to reorganize health systems to focus on life-long preventative and integrated measures. However, research is critical in determining how best to integrate these without further weakening health systems.
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Affiliation(s)
- Sharon Nobuntu Maseko
- Department of Optometry, School of Health Sciences, University of Kwa-Zulu Natal, Durban 4001, South Africa;
| | - Diane van Staden
- Department of Optometry, School of Health Sciences, University of Kwa-Zulu Natal, Durban 4001, South Africa;
| | - Euphemia Mbali Mhlongo
- Department of Nursing, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban 4001, South Africa;
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Ravindran RD, Gupta S, Haripriya A, Ravilla T, S AV, Subburaman GBB. Seven-year trends in cataract surgery indications and quality of outcomes at Aravind Eye Hospitals, India. Eye (Lond) 2021; 35:1895-1903. [PMID: 32913291 PMCID: PMC8225659 DOI: 10.1038/s41433-020-0954-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To report trends in cataract surgery indications, visual acuity outcomes, complication rates and reoperation rates at ten Aravind Eye Hospitals in Tamil Nadu, India. METHODS In this retrospective database study we analyzed seven years of data of cataract surgeries at Aravind during January 1, 2012 to December 31, 2018. Our main outcome measures were preoperative and 1-month postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); and rates of intraoperative complications and reoperations. We performed Cochran-Armitage trend tests. RESULTS In 1.86 million eyes that underwent cataract surgery, the percentage of eyes undergoing phacoemulsification (PE) showed an increasing trend (p < 0.0001), from 26.8% in 2012 to 33.5% in 2018. The percentage of eyes undergoing manual small incision cataract surgery (SICS) showed a decreasing trend (p < 0.0001), from 70.0% in 2012 to 65.1% in 2018. For SICS, the percentages of eyes with good postoperative UCVA and BCVA showed increasing trends (p < 0.0001 for each), and the percentages of eyes with poor postoperative UCVA and BCVA showed decreasing trends (p < 0.0001 for each). Results for PE surgeries were mixed. For both PE and SICS rates of intraoperative complications showed a declining trend (p < 0.0001 for each) and a slight increasing trend for reoperations (PE p < 0.02; SICS p < 0.0001). CONCLUSIONS During this seven-year period there were noticeable trends in cataract surgeries performed at Aravind in terms of the mix of surgical procedures, preoperative vision, and cataract surgical outcomes.
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Affiliation(s)
| | - Sachin Gupta
- SC Johnson College of Business, Cornell University, Ithaca, NY, USA
| | | | | | - Ashok Vardhan S
- Cataract Services, Sri Venkateswara Aravind Eye Hospital, Tirupati, India
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Pandya N, Gupta N, Nagpal D. Low vision: Knowledge, attitude, and practice among optometrists in India. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2021. [DOI: 10.1177/02646196211019071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a developing country like India, affordable eye care services are limited and less developed. Moreover, a general lack of awareness about proper vision care leads to a rise in the number of individuals with visual impairment. In developing countries like India, the low vision services are still growing. Hence, it becomes necessary to understand the knowledge and practice patterns among optometrists regarding low vision services. This was a cross-sectional study carried out from May 2020 to July 2020 among optometrists across India. The questionnaire was constructed using the information from the already existing literature, and content validity was done through experts in this field. Furthermore, this survey was circulated to 1374 optometrists in the form of Google survey. The participants were able to participate in the survey only after a written informed consent. Analysis was carried out using Statistical Package for the Social Sciences, Version 20.0 (SPSS, Inc., IBM), to report the knowledge, attitude, and practice of the low vision services in India. In total, 280 individuals participated in this survey, and the mean age of the participants was 28 ± 8 years. There were 156 (55.7%) females and 124 (44.3%) males with a response rate of 20.37%. Out of 280 participants, 184 (65.7%) were involved in clinical practice, whereas 96 (34.3%) in optical practice. Lack of accessibility and time were found to be the two major barriers to enhance knowledge in low vision; however, accessibility, lack of awareness, and cost were the hindering factors to practise low vision services among these participants. This study reports that accessibility to the low vision services and awareness about the services are the barriers to uptake of low vision services. Besides this awareness, training programmes and public awareness would effectively contribute to enhance low vision services.
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Affiliation(s)
- Nidhi Pandya
- Low Vision Specialist, Spects+Optometry Clinic, Gujarat, India
- Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, India
| | - Nayan Gupta
- Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, India
| | - Dimple Nagpal
- Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, India
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Kulkarni S, Ramachandran R, Sivaprasad S, Rani PK, Behera UC, Vignesh TP, Chawla G, Agarwal M, Mani SL, Ramasamy K, Raman R. Impact of treatment of diabetic macular edema on visual impairment in people with diabetes mellitus in India. Indian J Ophthalmol 2021; 69:671-676. [PMID: 33595499 PMCID: PMC7942112 DOI: 10.4103/ijo.ijo_2614_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The aim of this study was to report visual and anatomical outcomes following treatment for diabetic macular edema (DME) in clinical practice in India. Methods: Retrospective chart review of patients with DME who were initiated on treatment and followed up for at least 1 year at 9 tertiary eye care centers during 2016–2017 was performed. Data on demographics, systemic illnesses, visual acuity and anatomical characteristics of DME, treatment history were collated and analyzed for change in visual acuity level and central macular thickness at 1 year. Results: A total 1853 patients were diagnosed with treatable DME during study period, 1315 patients were treated and 556 patients (1019 eyes) followed up at one year. Although patients achieved significantly better anatomical outcome (central macular thickness of <300μ in 32.3% at baseline compared to 60.7% at 1 year, P < 0.001), visual impairment due to DME did not differ from baseline (mild visual impairment in 53.2% at baseline compared to 56% at 1 year, P = 0.7). Cystoid type of DME was the most common phenotype (432/1019, 42.4%) followed by spongy type (325, 31.9%) and cystoid plus spongy type (138, 13.5%). Bevacizumab monotherapy was the most common (388/1019, 38.1%) treatment followed by combination therapy (359, 35.2%). Mean number of anti-VEGF injections received per eye in a year was 2.1 (SD ± 0.9). Conclusion: Only about a third of treated DME patients complete one year follow up in India. Most patients receive suboptimal number of treatments. Treated DME cases largely show better anatomical outcome but not a better functional outcome.
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Affiliation(s)
- Sucheta Kulkarni
- Department of Retina, PBMA's H.V. Desai Eye Hospital, Pune, India
| | - Rajalakshmi Ramachandran
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London and University College London, London, UK
| | - Padmaja Kumari Rani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Umesh C Behera
- Department of Vitreo-Retina, L V Prasad Eye Institute, Bhubaneswar, India
| | - T P Vignesh
- Department of Retina-Vitreous, Aravind Eye Hospital, Madurai, India
| | - Gajendra Chawla
- Department of Retina, Vision Care & Research Centre, Bhopal, India
| | - Manisha Agarwal
- Department of Vitreoretina, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Sheena Liz Mani
- Department of Retina, Dr. Tony Fernandez Eye Hospital, Aluva, India
| | - Kim Ramasamy
- Department of Retina-Vitreous, Aravind Eye Hospital, Madurai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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22
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Kumar N, Dhingra D, Bhartiya S, Wadhwani M. Habitual visual acuity in a large urban cohort of Western India and factors influencing poor habitual vision. Indian J Ophthalmol 2021; 69:842-846. [PMID: 33727443 PMCID: PMC8012923 DOI: 10.4103/ijo.ijo_1501_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: The aim of this study was to determine habitual visual acuity (HVA) in a large urban cohort in western India and identify factors associated with poor HVA. Methods: This was a prospective study conducted over 10 days in September 2018 to assess the HVA in individuals attending a 10-day festival in Western India. Participants who volunteered to undergo vision screening and also filled the questionnaire form pertaining to demographic information including their age, gender, address, income, and educational status were included in this study. HVA was recorded with the distance correction that the participants were wearing when they attended the screening. The study evaluated the prevalence of visual acuity 6/6 or <6/6, 6/12, and 6/18 and the factors associated with lower visual acuity. Results: Of the 6300 participants, 1660 (26.3%) were females. Majority of the participants were from urban background (6084, 96.6%) and were of younger age group (18–40 years––3786, 60.1%; 41–60 years––2187, 34.7%; >60 years––327, 5.2%). HVA was recorded as 6/6 both eyes in 4136 (65.6%), at least 6/12 both eyes in 5691 (90.3%), and at least 6/18 both eyes in 5974 (94.8%) individuals. Only 11 patients (0.17%) had VA worse than 6/60 with only 3 patients (0.003%) having bilateral VA <6/60. Older age, female sex, lower education status, and low annual income were significant risk factors for poor HVA. Conclusion: Poor education, lower income, female gender, and old age are significantly associated with poor HVA even in urban Western India despite relatively easy access to affordable eye care facilities.
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Affiliation(s)
- Nishant Kumar
- Consultant Ophthalmologist and Retina Specialist, Hinduja Hospital, Mumbai, Maharashtra, India and Founder Trustee, Eyebetes Foundation, India
| | - Deepika Dhingra
- Consultant Ophthalmologist, Shah Satnam Ji Speciality Hospitals, Sirsa, Haryana, India
| | - Shibal Bhartiya
- Glaucoma Services, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Meenakshi Wadhwani
- Department of Ophthalmology, Chacha Nehru Bal Chikitsalaya, Delhi, India
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Marmamula S, Challa R, Khanna RC, Kunkunu E, Rao GN. Population-based Assessment of Vision Impairment in the Elderly Population in Telangana State in India - Policy Implications for Eye Health Programmes. Ophthalmic Epidemiol 2020; 28:144-151. [PMID: 32746673 DOI: 10.1080/09286586.2020.1797122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the prevalence, causes and risk factors for vision impairment (VI) among the elderly population in Telangana State, India. METHODS A population-based cross-sectional study were conducted in four districts. All participants had eye examinations including visual acuity assessment for distance and near, anterior segment examination and non-mydriatic fundus imaging by trained personnel. VI was defined as presenting visual acuity worse than 6/18 in the better eye. Individuals aged ≥60 years were considered as elderly. RESULTS In total, 11,238/12,150 (92.5%) individuals aged ≥40 years were examined. Of this, the dataset of 3,640 individuals (32.4%) elderly participants was used for analysis. Among the 3,640 participants, 53.1% were women and 78.1% had no education. The mean age of the participants was 67.8 years (standard deviation: 7 years; range: 60 to 102 years). The age and gender-adjusted prevalence of VI was 32.1% (95% CI: 29.5-34.8). On multivariable analysis, the odds of VI was significantly higher in older age groups, and among those with no education. Gender and district of residence were not associated with the prevalence of VI. Cataract (54.8%) was the leading cause of VI followed by uncorrected refractive errors (37.6%). CONCLUSIONS AND RELEVANCE VI was common and largely avoidable in the elderly population in Telangana state in India. Elderly centric eye care including screening for vision loss, provision of cataract surgery and spectacles can be used as strategies to address VI in the elderly.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.,Department of Biotechnology/Wellcome Trust India Alliance, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Eswararao Kunkunu
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Gullapalli N Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
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Marmamula S, Barrenkala NR, Challa R, Kumbam TR, Modepalli SB, Yellapragada R, Bhakki M, Khanna RC, Friedman DS. Uncorrected refractive errors for distance among the residents in 'homes for the aged' in South India-The Hyderabad Ocular Morbidity in Elderly Study (HOMES). Ophthalmic Physiol Opt 2020; 40:343-349. [PMID: 32207179 PMCID: PMC7277039 DOI: 10.1111/opo.12684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the prevalence and risk factors of Uncorrected Refractive Errors (URE) for distance in elderly residents in 'homes for the aged' in Hyderabad, India. METHODS Individuals aged ≥60 years and residing in 'homes for the aged' in Hyderabad, India for a minimum of 1 month and providing consent for participation were recruited. All participants underwent visual acuity assessment, refraction, slit lamp biomicroscopy, intraocular pressure measurement, fundus examination, and retinal imaging. Monocular presenting visual acuity was recorded using a logMAR chart. Objective and subjective refraction were performed, and best-corrected visual acuity was recorded. URE was defined as presenting visual acuity worse than 6/12 but improving to 6/12 or better with refraction. Univariable and multivariable logistic regression analyses were used to assess the risk factors associated with URE. RESULTS In total, 1 513 elderly participants were enumerated from 41 homes of which 1 182 participants (78.1%) were examined. The mean age of participants was 75.0 years (standard deviation 8.8 years; range: 60-108 years). 35.4% of those examined were men and 20.3% had no formal education. The prevalence of URE was 13.5% (95% CI: 11.5-15.5; n = 159). On applying multiple logistic regression analysis, compared to those living in private homes, the odds of URE were significantly higher among the elderly living in the aided homes (OR: 1.65; 95% CI: 1.11-2.43) and free homes (OR: 1.67; 95% CI: 1.00-2.80). As compared to those who reported having an eye examination in the last 3 years, the odds of URE were higher among those who never had an eye examination in the last three years (OR: 1.51; 95% CI: 1.07-2.14). Similarly, those who had unilateral cataract surgery (OR: 1.80; 95% CI: 1.10-2.93) or bilateral cataract surgery (1.69; 95% CI: 1.10-2.56) had higher odds of URE compared to those elderly who were not operated for cataract. Gender, self-report of diabetes, and education were not associated with URE. CONCLUSIONS A large burden of URE was found among the residents in the 'homes for the aged' in Hyderabad, India which could be addressed with a pair of glasses. Over 40% of the residents never had an eye examination in the last three years, which indicates poor utilisation of eye care services by the elderly. Regular eye examinations and provision of spectacles are needed to address needless URE for distance among the elderly in residential care in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
- Wellcome Trust/Department of Biotechnology India AllianceL V Prasad Eye InstituteHyderabadIndia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
- Department of OphthalmologyMassachusetts Eye and EarHarvard Medical SchoolBostonUSA
| | - Navya Rekha Barrenkala
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Rajesh Challa
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Thirupathi Reddy Kumbam
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Madhuri Bhakki
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
| | - David S Friedman
- Department of OphthalmologyMassachusetts Eye and EarHarvard Medical SchoolBostonUSA
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Zhang XJ, Leung CK, Li EY, Musch DC, Zheng CR, He MG, Chang DF, Lam DS. Diagnostic Accuracy of Rapid Assessment of Avoidable Blindness: A Population-based Assessment. Am J Ophthalmol 2020; 213:235-243. [PMID: 31846622 DOI: 10.1016/j.ajo.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of rapid assessment of avoidable blindness (RAAB). DESIGN Population-based diagnostic accuracy study. METHODS A total of 2145 (95.3%, 2145/2250) subjects aged 50 years and older who participated in the RAAB survey were included. All the recruited participants underwent ophthalmic examination according to the RAAB protocol and then were reexamined with instruments in a mobile eye clinic set up in a village center on the same day. Examination in the mobile clinic included standardized visual acuity (VA) tests using logMAR charts, refraction, slit-lamp biomicroscopy, and dilated fundal examination with a binocular indirect ophthalmoscope. Blindness and economic blindness were defined as VA in the better-seeing eye <3/60 and <6/60, respectively. Visual impairment (VI) was defined as VA <6/18 in the better eye. The primary cause of blindness and VI was defined according to the cause of VI in the participant's better eye. MAIN OUTCOME MEASURES The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) of receiver operating characteristics of RAAB for detection of blindness and the principal causes of VI. RESULTS A total of 1816 subjects (84.7%), including 686 men (37.8%) and 1130 women (62.2%), underwent ophthalmic examination in the mobile eye clinic. The mean (±standard deviation) age was 64.4 ± 9.6 years. The sensitivities, specificities, AUC, PLR, and NLR of RAAB were 90.3%, 99.3%, 0.948, 124.0, and 0.10, respectively, for detection of blindness (presenting visual acuity, PVA <3/60); 89.5%, 98.7%, 0.940, 69.2, and 0.11, respectively, for detection of economic blindness (PVA <6/60); and 90.3%, 97.7%, 0.940, 38.7, and 0.10, respectively, for detection of VI (PVA <6/18). The sensitivities, specificities, AUC, PLR, and NLR were 90.5%, 98.1%, 0.943, 48.1, and 0.10; and 60.4%, 98.7%, 0.796, 46.4, and 0.40 for detection of VI (PVA <6/18) owing to cataract and refractive error, respectively. CONCLUSION The diagnostic performances of RAAB were high for detecting the prevalence of blindness, VI, and VI owing to cataract.
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Marmamula S, Barrenakala NR, Challa R, Kumbham TR, Modepalli SB, Yellapragada R, Bhakki M, Khanna RC, Friedman DS. Prevalence and risk factors for visual impairment among elderly residents in 'homes for the aged' in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES). Br J Ophthalmol 2020; 105:32-36. [PMID: 32217544 PMCID: PMC7116480 DOI: 10.1136/bjophthalmol-2019-315678] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/03/2020] [Accepted: 03/02/2020] [Indexed: 12/02/2022]
Abstract
Background/Aim To investigate the prevalence, causes and risk factors of visual impairment (VI) among the elderly in ‘home for the aged’ in Hyderabad, India. Methods Individuals aged ≥60 years were recruited from 41 ‘homes for the aged’. All participants had complete eye examinations including presenting visual acuity, refraction, slit-lamp examination, intraocular pressure measurement and fundus imaging by trained clinicians. VI was defined as presenting visual acuity worse than 6/18 in the better eye. Multivariate logistic regression was used to determine the risk factors associated with VI. Results 1512 elderly residents from 41 homes for the aged were enumerated, of whom 1182 (78.1%) were examined. The mean age of examined participants was 75.0 years (SD 8.8 years; range: 60–108 years); 35.4% of those examined were men. The prevalence of VI was 30.1% (95% CI 27.5 to 32.8). The leading cause of VI was cataract (46.3%, n=165), followed by uncorrected refractive error (27.0%, n=96), posterior capsular opacification (14.9%, n=53) and posterior segment disease (6.5%, n=23). Overall, 88.2% of the VI was either treatable or correctable. In multiple logistic regression, those aged 80 years and older (OR: 1.7, p<0.01), living in ‘free’ homes (OR: 1.5, p<0.01) and who were immobile/bedridden (OR: 3.02, p<0.01) had significantly higher odds of VI. Gender was not associated with VI. Conclusions VI was common and largely avoidable in residents of ‘homes for the aged’ in Hyderabad, India. Screening for vision loss in ‘homes for aged’ and the provision of appropriate services should become routine practice to achieve the goal of healthy ageing in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India .,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Wellcome Trust / Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India.,Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology, Boston, US
| | - Navya Rekha Barrenakala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Madhuri Bhakki
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology, Boston, US
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Das AV, Basu S. Indications and prognosis for keratoplasty in eyes with severe visual impairment and blindness due to corneal disease in India. Br J Ophthalmol 2020; 105:17-21. [PMID: 32188677 DOI: 10.1136/bjophthalmol-2019-315361] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/01/2020] [Accepted: 02/29/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To describe the indications and prognosis for keratoplasty in eyes with severe visual impairment and blindness due to corneal diseases in India. METHODS This hospital-based cross-sectional study included 1 057 215 new patients presenting to a multitier ophthalmology network from 2016 to 2018. All patients with a central corneal pathology and best corrected visual acuity of less than 20/200 in the affected eye(s) were identified as cases and grouped according to laterality. The main outcome measure was the prognosis for keratoplasty, based on the surgical indication. RESULTS A total of 28 824 (2.73%) patients were identified with severe visual impairment or blindness due to corneal diseases; of which, 22 582 (78.3%) had unilateral and 6242 (21.7%) had bilateral affliction. Overall, 85% of the corneal pathologies were due to avoidable causes, which accounted for 97% and 63% of the unilateral and bilateral cases, respectively (p<0.0001). The most common aetiologies were microbial keratitis (27.2%) and corneal opacification (25.5%) in unilateral cases; and corneal opacification (38.2%) and ectasias (14.5%) in bilateral cases. Overall, 60.1% of affected eyes carried a fair to poor prognosis for keratoplasty. However, while in unilateral cases only 29.9% of eyes carried good to excellent prognosis for keratoplasty, in bilateral cases, 58% of eyes carried good to excellent prognosis for keratoplasty (p<0.0001). CONCLUSIONS The indications and prognosis for keratoplasty varied greatly based on whether the affliction was unilateral or bilateral. Most of the eyes affected by corneal visual impairment or blindness, however, carried an unfavourable prognosis for keratoplasty.
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Affiliation(s)
- Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India .,The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Misra N, Khanna RC. Commentary: Rapid assessment of avoidable blindness and diabetic retinopathy in India. Indian J Ophthalmol 2020; 68:381-382. [PMID: 31957733 PMCID: PMC7003596 DOI: 10.4103/ijo.ijo_1133_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Neha Misra
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Mohanty S, Jolley E, Mohanty RN, Buttan S, Schmidt E. Integrating Geospatial Data and Measures of Disability and Wealth to Assess Inequalities in an Eye Health Survey: An Example from the Indian Sunderbans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234869. [PMID: 31816932 PMCID: PMC6926603 DOI: 10.3390/ijerph16234869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 11/16/2022]
Abstract
The Sunderbans are a group of delta islands that straddle the border between India and Bangladesh. For people living on the Indian side, health services are scarce and the terrain makes access to what is available difficult. In 2018, the international non-governmental organisation Sightsavers and their partners conducted a population-based survey of visual impairment and coverage of cataract and spectacle services, supplemented with tools to measure equity in eye health by wealth, disability, and geographical location. Two-stage cluster sampling was undertaken to randomly select 3868 individuals aged 40+ years, of whom 3410 were examined. Results were calculated using standard statistical processes and geospatial approaches were used to visualise the data. The age-sex adjusted prevalence of blindness was 0.8%, with higher prevalence among women (1.1%). Cataract Surgical Coverage for eyes at visual acuity (VA) 3/60 was 86.3%. The study did not find any association between visual impairment and wealth, however there were significant differences by additional (non-visual) disabilities at all levels of visual impairment. Geospatial mapping highlighted blocks where higher prevalence of visual impairment was identified. Integrating additional tools in population-based surveys is critical for measuring eye health inequalities and identifying population groups and locations that are at risk of being left behind.
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Affiliation(s)
- Soumya Mohanty
- Monitoring Evaluation Research and Learning, Sightsavers India 110020, India;
| | - Emma Jolley
- Research, Sightsavers, Haywards Heath RH16 3BW, UK
- Correspondence: ; Tel.: +44-1444-446686
| | - RN Mohanty
- India Directorate Sightsavers India 110020, India;
| | - Sandeep Buttan
- Programme Development and Innovation Team, Sightsavers India 110020, India;
| | - Elena Schmidt
- Programme Development, Evidence and Research, Sightsavers, Haywards Heath RH16 3BW, UK;
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Gogate P, Biswas P, Das T, Nirmalan P, Natarajan S. Ophthalmology residency training in India: Comparing feedback about how the training equips ophthalmologists to combat retinal diseases. READS report #6. Indian J Ophthalmol 2019; 67:1816-1819. [PMID: 31638039 PMCID: PMC6836610 DOI: 10.4103/ijo.ijo_1960_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/21/2019] [Accepted: 07/23/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To document whether the residency training in management of retinal diseases has improved in 2000s to meet the increasing demand of retina care in India. Methods A survey, using a prevalidated questionnaire, was conducted by Academic and Research Committee (ARC) of the All India Ophthalmological Society (AIOS) in 2014-2016 among ophthalmologists to document teaching of retina-related clinical and surgical skills in the postgraduate residency program. Results The 144-item questionnaire was mailed to 4512 practicing ophthalmologists with residency training in two different periods, between 1967 and 2000 (group 1; 20th-century trained) and between 2003 and 2012 (group 2; 21st-century trained). Response was received from 320 (19.1%) of group 1 ophthalmologists and 531 (18.7%) of group 2 ophthalmologists. The average age was 49.2 ± 8.7 and 32.6 ± 4 years, respectively. Group 2 residents had received superior training in indirect ophthalmoscopy, slit lamp biomicroscopy using + 78 and + 90D lens, optical coherence tomography, fundus photography, and fluorescein angiography (all P < 0.001), but there was large variation between the training institutions. The residents were not taught vitreous and retinal detachment surgeries in either period of training. Conclusion Teaching of retina-related clinical skills have improved in Indian residency program, but there are variations across programs. This information might help redesign the ophthalmology residency programs to meet the demands of comprehensive eye care and universal health coverage of increasing retinal diseases in India.
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Affiliation(s)
- Parikshit Gogate
- Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
- Department of Ophthalmology, D.Y. Patil Medical College, Pune, Maharashtra, India
| | | | - Taraprasad Das
- L.V. Prasad Eye Institute, Hyderabad, Telangana, India
- L V Prasad, Eye Institute, Bhubaneshwar, Odisha, India
| | - Praveen Nirmalan
- Independent Researcher, Aditya Jyot Eye Hospital, Mumbai, Maharashtra, India
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Soni P, Bodakhe SH. Protective effect of Coleus forskohlii leaf-extract compound on progression of cataract against Fructose-Induced experimental cataract in rats. Drug Chem Toxicol 2019; 45:170-179. [PMID: 31547727 DOI: 10.1080/01480545.2019.1668404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present study was designed to determine protective effects of Coleus forskohlii hydroalcoholic leaf-extract along with its fractions against fructose-induced cataract rat model. The Coleus forskolii leaf extract was subjected to silica gel column chromatography and fractions were collected. A major high yielding fraction of the leaf extract, designated as fraction B6 was pharmacologically evaluated in Sprague Dawley albino rats at three doses 0.1, 1 and 10 mg/kg respectively. Compound B2; isolated from B6 fraction, identified as 'gallic acid' was also pharmacologically evaluated at three different doses. Cataract was induced by concurrent administration of fructose solution (10% w/v, per oral, dissolved in drinking water) for eight consecutive weeks. Mean arterial pressure, blood glucose level and lenticular opacity were determined. At the end of eight weeks, C. forskohlii leaf extract fraction and gallic acid reduced mean arterial pressure and glucose level in a dose dependent manner. In addition, C. forskohlii led to significant restoration of lens antioxidants enzyme level and reduced cataract formation in rats. These results showed the concentration dependent protective effect by C. forskohlii leaf extract against cataract formation due to restoration of oxidative stress markers.
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Affiliation(s)
- Pranay Soni
- SLT Institute of Pharmaceutical Sciences, Guru Ghasidas Vishwavidyalaya , Bilaspur , India
| | - Surendra H Bodakhe
- SLT Institute of Pharmaceutical Sciences, Guru Ghasidas Vishwavidyalaya , Bilaspur , India
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Lou L, Ye X, Xu P, Wang J, Xu Y, Jin K, Ye J. Association of Sex With the Global Burden of Cataract. JAMA Ophthalmol 2019; 136:116-121. [PMID: 29242928 DOI: 10.1001/jamaophthalmol.2017.5668] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Eye disease burden could help guide health policy making. Differences in cataract burden by sex is a major concern of reducing avoidable blindness caused by cataract. Objective To investigate the association of sex with the global burden of cataract by year, age, and socioeconomic status using disability-adjusted life-years (DALYs). Design, Setting, and Participants This international, comparative burden-of-disease study extracted the global, regional, and national sex-specific DALY numbers, crude DALY rates, and age-standardized DALY rates caused by cataract by year and age from the Global Burden of Disease Study 2015. The DALY data were collected from January 1, 1990, through December 31, 2015, for ever 5 years. The human development index (HDI) in 2015 was extracted as an indicator of national socioeconomic status from the Human Development Report. Main Outcomes and Measures Comparisons of sex-specific DALY estimates due to cataract by year, age, and socioeconomic status at the global level. Paired Wilcoxon signed rank test, Pearson correlation, and linear regression analyses were performed to evaluate the socioeconomic-associated sex differences in cataract burden. Results Differences in rates of cataract by sex were similar between 1990 and 2015, with age-standardized DALY rates of 54.5 among men vs 65.0 among women in 1990 and 52.3 among men vs 67.0 among women in 2015. Women had higher rates than men of the same age, and sexual differences increased with age. Paired Wilcoxon signed rank test revealed that age-standardized DALY rates among women were higher than those among men for each HDI-based country group (z range, -4.236 to -6.093; P < .001). The difference (female minus male) in age-standardized DALY rates (r = -0.610 [P < .001]; standardized β = -0.610 [P < .001]) and the female to male age-standardized DALY rate ratios (r = -0.180 [P = .02]; standardized β = -0.180 [P = .02]) were inversely correlated with HDI. Conclusions and Relevance Although global cataract health care is progressing, sexual differences in cataract burden showed little improvement in the past few decades. Worldwide, women have a higher cataract burden than men. Older age and lower socioeconomic status are associated with greater differences in rates of cataract by sex. Our findings may enhance public awareness of sexual differences in global cataract burden and emphasize the importance of making sex-sensitive health policy to manage global vision loss caused by cataract.
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Affiliation(s)
- Lixia Lou
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Ye
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Peifang Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyi Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yufeng Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kai Jin
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Juan Ye
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Muhammad N, Adamu MD, Mpyet C, Bounce C, Maishanu NM, Jabo AM, Rabiu MM, Bascaran C, Isiyaku S, Foster A. Impact of a 10-Year Eye Care Program in Sokoto, Nigeria: Changing Pattern of Prevalence and Causes of Blindness and Visual Impairment. Middle East Afr J Ophthalmol 2019; 26:101-106. [PMID: 31543668 PMCID: PMC6737780 DOI: 10.4103/meajo.meajo_113_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: This study was undertaken to ascertain the current magnitude and causes of blindness and visual impairment in persons aged 50 years and over and to assess the impact of a 10-year eye care program in Sokoto State, Nigeria. METHODS: A rapid assessment of avoidable blindness (RAAB) survey (in persons 50 years and over) was conducted in 2016. Participants were selected in Wurno health zone using a two-stage cluster randomized sampling with probability proportional to size. Operational definitions were based on RAAB and World Health Organization eye examination record definitions. Eye care program documents were reviewed and data from a baseline survey undertaken in 2005 were reanalyzed. RESULTS: A response of 89.1% (2405 of 2700 participants) was obtained in the 2016 survey. With available correction, the unadjusted prevalence of blindness was 7.7% (95% confidence interval [CI]: 6.4, 8.9). The odds of blindness were 1.8 times higher in females than males (95% CI: 1.3, 2.4; P < 0.001). Major causes of blindness were cataract (48.9%) corneal disease (20.1%), glaucoma (10.3%), and uncorrected refractive error/aphakia (8.7%). The age- and sex-adjusted prevalence of blindness has declined from 11.6% (95% CI: 7.4, 17.0) in 2005 to 6.8% (95% CI: 5.6, 8.0%) in 2016. CONCLUSION: The blindness prevalence is high, and the major causes are avoidable in the health zone. The findings suggest that investments in the program over the last 10 years might have led to almost a halving in the prevalence of blindness in th e population. However, the small sample size of persons 50+ years from Wurno zone in the 2005 survey necessitate caution when comparing the 2005 and the 2016 surveys.
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Affiliation(s)
- Nasiru Muhammad
- Department of Ophthalmology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Mohammed D Adamu
- Department of Ophthalmology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria.,Sightsavers Nigeria Office, Kaduna, Nigeria.,Division of Ophthalmology, Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa
| | - Catey Bounce
- Department of Primary Care and Public Health Sciences, King's College, London, United Kingdom
| | - Nuhu M Maishanu
- Sokoto State Eye Health Programme, Ministry of Health, Sokoto, Nigeria
| | | | | | - Covadonga Bascaran
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Allen Foster
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Kulkarni S, Kondalkar S, Mactaggart I, Shamanna BR, Lodhi A, Mendke R, Kharat J, Kapse R, Dole K, Deshpande M. Generating evidence for planning eye care service delivery in an urban underprivileged population setting in Pune, Western India. BMJ Open Ophthalmol 2019; 4:e000202. [PMID: 31414051 PMCID: PMC6668608 DOI: 10.1136/bmjophth-2018-000202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To estimate prevalence of blindness, diabetic retinopathy and causes of blindness through rapid assessment of avoidable blindness (RAAB) survey in Pune, India to develop an evidence base for planning urban eye care services. Methods ‘Rapid assessment of avoidable blindness and diabetic retinopathy’ methodology was used. Compact segment sampling was used in each of the 60 selected electoral wards identified through cluster selection module of the RAAB software using probability proportionate to size method. Persons >50 years of age were enumerated from selected segments to achieve cumulative target of 60/day by two teams. Participants underwent presenting and pinhole visual acuity (VA) testing in each eye. A torch light examination and direct ophthalmoscopy established cause of visual impairment/blindness if present. Data were entered into and analysed using RAAB software. Results The response rate was 89.5% (3221/3600), and 55.3% were women. Results of only RAAB module are presented in this paper. Age-standardised and sex-standardised prevalence of blindness was 1.3% (95% CI 0.9 to 1.8). Cataract was the most common cause of blindness (45.7%) followed by overall posterior segment disorders (39.1%). Cataract surgical outcome was good (VA>6/18) or very good (VA>6/12) in 805/1190 (67.6%) cases. Cataract surgical coverage was 96.7%. ‘Need not felt’ (36.6%) and ‘cost’ (31.7%) were the most common barriers for cataract surgery. Conclusion Prevalence of blindness is showing declining trend in urban India. Cataract remains a major cause of blindness followed by posterior segment disorders. Social marketing, and referral linkages between community and service providers were planned after this survey.
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Affiliation(s)
- Sucheta Kulkarni
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Shridevi Kondalkar
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Islay Mactaggart
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - B R Shamanna
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Azher Lodhi
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Rohit Mendke
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Jitesh Kharat
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Rajesh Kapse
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Kuldeep Dole
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
| | - Madan Deshpande
- Department of community ophthalmology, PBMA's H. V. Desai Eye Hospital, Pune, India
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Sheeladevi S, Seelam B, Nukella PB, Borah RR, Ali R, Keay L. Prevalence of refractive errors, uncorrected refractive error, and presbyopia in adults in India: A systematic review. Indian J Ophthalmol 2019; 67:583-592. [PMID: 31007213 PMCID: PMC6498913 DOI: 10.4103/ijo.ijo_1235_18] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: The objective of this review is to estimate the prevalence of refractive errors, uncorrected refractive error (URE), and uncorrected presbyopia in adults aged ≥30 years in India. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. A detailed literature search was performed to include all studies published from India from the year 1990 using the Cochrane Library, Medline, and Embase. Refractive error was defined by >0.50 D ametropia. URE was defined by presenting visual acuity (PVA) worse than 6/18 improving with pinhole or spectacle correction, and uncorrected presbyopia by near vision <N8 improving with correction in the absence of distance URE. Results: Fifteen studies were included from South India, one each from Western and Central India, and one study covered 15 states across India. The prevalence of RE of at least 0.50 D of spherical equivalent ametropia was 53.1% [(95% confidence interval (CI): 37.2–68.5), of which myopia and hyperopia was 27.7% and 22.9%, respectively. The prevalence of URE was 10.2% (95% CI: 6.9–14.8), but heterogeneity in these estimates was very high. The prevalence of uncorrected presbyopia was 33% (95% CI: 19.1–51.0). Conclusion: This review highlights the magnitude of refractive errors among adults in India. More studies are needed using standard methods in regions where there is a lack of information on UREs. Programs delivering spectacles for adults in India will need to primarily focus on reading glasses to correct presbyopia along with spectacles for hyperopia and myopia.
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Affiliation(s)
- Sethu Sheeladevi
- Division of Optometry and Visual Sciences, City University of London, London, UK
| | - Bharani Seelam
- Injury Division, The George Institute for Global Health; UNSW Sydney, Australia
| | | | | | | | - Lisa Keay
- Injury Division, The George Institute for Global Health; UNSW Sydney, Australia
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Jain S, Rajshekar K, Aggarwal A, Chauhan A, Gauba VK. Effects of cataract surgery and intra-ocular lens implantation on visual function and quality of life in age-related cataract patients: a systematic review protocol. Syst Rev 2019; 8:204. [PMID: 31409420 PMCID: PMC6693150 DOI: 10.1186/s13643-019-1113-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cataract is the leading cause of blindness and low vision worldwide. Presently, cataract surgery is the only treatment for cataract and is very effective in restoring sight. In cataract surgery, the natural lens of the eye that becomes clouded is removed and replaced with an artificial intraocular lens. There are multiple techniques for removal of lens as well as many types of intraocular lenses available for implantation. For this reason, it becomes imperative to monitor the impact of different surgical techniques and different intraocular lenses on health-related quality of life (HRQoL) of the patients. This systematic review aims to evaluate HRQoL evidences on effects of different types of cataract surgeries and intraocular lenses on visual function and quality of life in age-related cataract patients. METHOD Databases like Cochrane, EMBASE, SCOPUS, NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) database, MEDLINE, ClinicalTrials.gov , Current Controlled Trials and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) will be searched systematically. Two reviewers will independently screen studies using predefined inclusion and exclusion criteria along with the extraction of data, and assessment of methodological quality using a standard checklist. DISCUSSION This systematic review will help in understanding how different types of cataract surgeries and intraocular lenses make a difference on quality of life of age-related cataract patients in terms of visual function and health-related quality of life. As the review attempts to bring together all the cataract-related HRQoL evidences pertaining to different cataract surgical techniques, different intraocular lenses and cataract-related complications, it will also identify gaps in evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018092377.
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Affiliation(s)
- Shalu Jain
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
| | - Kavitha Rajshekar
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
| | - Anjana Aggarwal
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
| | - Akshay Chauhan
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
| | - Vijay Kumar Gauba
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
- Indian Council of Medical Research, (ICMR), New Delhi, India
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Marmamula S, Khanna RC, Yellapragada S, Challa R, Mohd J, Rao GN. Temporal trends in the prevalence and causes of visual impairment in the South Indian state of Telangana: a population-based cross-sectional study. BMJ Open 2019; 9:e029114. [PMID: 31345976 PMCID: PMC6661589 DOI: 10.1136/bmjopen-2019-029114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the temporal trends in the prevalence and causes of visual impairment (VI) in South India. DESIGN Population-based cross-sectional studies conducted during the years 2011-2012 and 2017 using identical study methods and in geographical locations are compared. The L V Prasad Eye Institute established services in Khammam and not in Warangal district after the 2011-2012 study. SETTING Khammam and Warangal districts in Telangana, India. PARTICIPANTS In total, 5357 participants aged ≥40 years were examined from two districts in the 2011-2012 study and 4923 participants were examined in the 2017 study. MAIN OUTCOME MEASURES Age-adjusted and gender-adjusted temporal trends in the prevalence and causes of VI.Blindness and moderate VI (MVI) were defined as presenting visual acuity worse than 6/60 and 6/18-6/60 in the better eye, respectively. VI included MVI and blindness. RESULTS Nearly 2500 participants were examined in each location in both the 2011-2012 and 2017 studies. In Khammam district, overall VI declined by 2.5% from 15.5% to 13.0% (p<0.001). While there was no significant change in MVI (p=0.566), blindness declined by 3.0% from 5.4% to 2.4% (p<0.001). In Warangal district, the overall VI remained unchanged (p=0.60). While MVI increased by 3% from 9.3% to 12.3% (p=0.001), blindness declined by 3.5% from 6.5% to 3.0% (p<0.001). While MVI due to cataract increased in both districts, there was a significant decline in MVI due to refractive errors in Khammam. CONCLUSION There was a significant decline in VI in Khammam district but not in Warangal district. The differential trends in prevalence and causes of VI can be explained by the availability and uptake of eye care services in these two districts.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
- WellcomeTrust / Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, Telangana, India
- School of Optometry and Vision Science, University of South Wales, Sydney, NSW, Australia
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- School of Optometry and Vision Science, University of South Wales, Sydney, NSW, Australia
| | - Shashank Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Javed Mohd
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gullapalli Nageswara Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Lepcha NT, Sharma IP, Sapkota YD, Das T, Phuntsho T, Tenzin N, Shamanna BR, Peldon S. Changing trends of blindness, visual impairment and cataract surgery in Bhutan: 2009-2018. PLoS One 2019; 14:e0216398. [PMID: 31071127 PMCID: PMC6508732 DOI: 10.1371/journal.pone.0216398] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/20/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose To obtain new rapid assessment of avoidable blindness (RAAB) data on the prevalence, causes and trends of blindness, visual impairment and cataract surgery; and compare the new 2018 data with the older RAAB 2009 data. Methodology The second nationwide RAAB used android based mRAAB technique and technology for data collection. Using the compact segment sampling probability proportionate to size, 5,050 participants from 101 clusters of 50 people aged 50 years and older were enrolled through house-to-house visits. Eligible participants received ophthalmic examination and interview by the ophthalmologist-led emuneration team as per the RAAB protocol. Results The age-sex adjusted magnitude of bilateral blindness in Bhutan was 1.0% (95% Confidence Interval, CI 0.5–1.4) with relatively higher prevalence in rural population (Odds Ratio, OR 1.5, p = 0.13) and women (OR 1.6, p = 0.06). Untreated cataract accounted for the most of blindness (53.8%), severe vision impairment (57.1%), and moderate visual impairment (65.3%); uncorrected refractive error was the main cause of early visual impairment (46.7%). Cataract Surgical Coverage was 86.1% with relatively better coverage in men (76.7% men; 73.1% female) and urban population (79.2% urban; 70.2% rural). Good cataract surgical outcome was achieved in 67.3% and leading cause of poor outcome was ocular comorbidity (43.6%). Accessibility was a significant barrier to the uptake of cataract surgical services. Conclusion There is a 33% reduction in blindness from 1.5% to 1.0%, since the first RAAB survey in 2009. In order to further reduce blindness and visual impairment, Bhutan should continue to implement long-term strategic action plan for eye health focused on strengthening primary eye care and comprehensive eye care service.
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Affiliation(s)
- Nor Tshering Lepcha
- Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan
- * E-mail:
| | - Indra Prasad Sharma
- Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan
| | - Yuddha Dhoj Sapkota
- International Agency for Prevention of Blindness, South East Asia Regional Office, Banjara Hills, Hyderabad, India
| | - Taraprasad Das
- International Agency for Prevention of Blindness, South East Asia Region, Kallam Anji Reddy Campus, L V Prasad Marg, Hyderabad, India
| | - Tshering Phuntsho
- Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan
| | - Ngawang Tenzin
- Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan
| | | | - Sonam Peldon
- Primary Eye Care Program, Ministry of Health, Thimphu, Bhutan
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Ambastha A, Kusumesh R, Sinha S, Sinha BP, Bhasker G. Causes of visual impairment in applications for blindness certificates in a tertiary center of Bihar and its role in health planning. Indian J Ophthalmol 2019; 67:204-208. [PMID: 30672470 PMCID: PMC6376837 DOI: 10.4103/ijo.ijo_837_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To analyze applications for blindness certificates to find causes of visual impairment (VI), handicap, and blindness in a tertiary hospital of Bihar. Methods: Applications for blindness certificates were analyzed over a two-year period. The main cause of blindness, visual handicap, and VI in these applications was ascertained by age group and etiology. VI disability percentages and definitions proposed by Governmen of India (category 0–4; 20–100%) were used to categorize and give percentage to all applicants. Results were compared with data from studies on blindness certificates and population based studies. Results: In total, 203 applicants were reviewed. Mean age was 23.5 ± 7.9 years. Overall, most common cause of visual handicap (40–100% impairment) and blindness (75–100% impairment) was macular pathology (P<.05), while most common cause of overall VI (20–100% impairment) was amblyopia. In age group 0–15 years, most common causes of blindness/visual handicap were congenital globe and hereditary retinal or optic nerve disorders (P = 0.016). In age group 16–30 years, macular pathology was the most common cause of visual handicap [P = 0.007], while amblyopia was the most common cause of VI [P = 0.00]. Between 31 and 45 years of age group, corneal scar in one eye was the most common cause of VI, while macular scar in both eyes was the most common cause of visual handicap. Glaucoma and diabetic retinopathy were the most common causes of blindness/visual handicap between 46 and 65 years and above 65 years of age, respectively. Data about causes of VI such as amblyopia, complicated cataract surgery, and one eyed blindness could not be ascertained by analyzing blindness certificate alone. Conclusion: Data from applications for blindness certificates provide valuable information regarding different causes of VI that might otherwise not be eligible for blindness certification and provide an insight into the overall trends in disease profile and service delivery.
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Affiliation(s)
- Anita Ambastha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shalini Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Bibhuti P Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Gyan Bhasker
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Vignesh D, Gupta N, Kalaivani M, Goswami AK, Nongkynrih B, Gupta SK. Prevalence of visual impairment and its association with vision-related quality of life among elderly persons in a resettlement colony of Delhi. J Family Med Prim Care 2019; 8:1432-1439. [PMID: 31143735 PMCID: PMC6510070 DOI: 10.4103/jfmpc.jfmpc_188_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The population of India is ageing. The number and percentage of elderly persons is increasing. Visual impairment is common among elderly persons and affects their vision-related quality of life. The objective of this study was to estimate the prevalence of visual impairment among elderly persons aged 60 years and above residing in a resettlement colony of Delhi and study its association with socio-demographic variables and vision-related quality of life. Methods: A total of 604 elderly participants were selected by simple random sampling. House-to-house visit was done, and a self-developed pre-tested semi-structured interview schedule was used to collect socio-demographic information. Visual acuity was measured using Snellen's chart, and distant direct ophthalmoscopy was done to diagnose cataract. Vision-related quality of life was assessed by Indian Vision Function Questionnaire-33 (IND-VFQ-33). Results: Of the 604 participants, 555 (91.9%) were available for interview. The prevalence of visual impairment was 24.5% (95% CI: 20.9% - 28.1%). Cataract was the leading cause of visual impairment (50.7%), followed by uncorrected refractive error (36.8%). Illiteracy (aOR: 3.49, 1.37-8.87), economic dependence on family members (aOR: 1.92, 1.04 – 3.54), not currently working (aOR: 1.89, 1.20-2.98) and chewing of tobacco products (aOR: 2.56, 1.48-4.42) were significantly associated with visual impairment among study participants. Vison-related quality of life was worse among those with visual impairment. Conclusion: Burden of visual impairment is high among elderly persons living in urban resettlement colonies. It is largely avoidable. Eye-care services should be accessible and affordable to them.
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Affiliation(s)
- Dwarakanathan Vignesh
- Centre for Community Medicine, All lndia lnstitute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Dr. R. P. Centre for Ophthalmic Sciences, All lndia lnstitute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All lndia lnstitute of Medical Sciences, New Delhi, India
| | - Anil Kumar Goswami
- Centre for Community Medicine, All lndia lnstitute of Medical Sciences, New Delhi, India
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All lndia lnstitute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All lndia lnstitute of Medical Sciences, New Delhi, India
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Das T. Blindness and Visual Impairment Profile and Rapid Assessment of Avoidable Blindness in South East Asia: Analysis of New Data. 2017 APAO Holmes Lecture. Asia Pac J Ophthalmol (Phila) 2018; 7:312-315. [PMID: 29532647 DOI: 10.22608/apo.2017425] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The International Agency for Prevention of Blindness (IAPB) South East Asia region (SEAR) that consists of 11 countries contains 26% of the world's population (1,761,000,000). In this region 12 million are blind and 78.5 million are visually impaired. This amounts to 30% of global blindness and 32% of global visual impairment. DESIGN Rapid assessment of avoidable blindness (RAAB) survey analysis. METHODS RAAB, either a repeat or a first time survey, was completed in 8 countries in this decade (2010 onwards). These include Bangladesh, Bhutan, India, Indonesia, Maldives, Sri Lanka, Thailand, and Timor Leste. RESULTS Cataract is the principal cause of blindness and severe visual impairment in all countries. Refractive error is the principal cause of moderate visual impairment in 4 countries: Bangladesh, India, Maldives, and Sri Lanka; cataract continues to be the principal cause of moderate visual impairment in 4 other countries: Bhutan, Indonesia, Thailand, and Timor Leste. Outcome of cataract surgery is suboptimal in the Maldives and Timor Leste. CONCLUSIONS Rigorous focus is necessary to improve cataract surgery outcomes and correction of refractive error without neglecting the quality of care. At the same time allowances must be made for care of the emerging causes of visual impairment and blindness such as glaucoma and posterior segment disorders, particularly diabetic retinopathy.
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Affiliation(s)
- Taraprasad Das
- L V Prasad Eye Institute, Hyderabad, India
- International Agency for Prevention of Blindness, South East Asia
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Saluja G, Takkar B, Agarwal E, Sharma B, Khokhar S. Planning a new intraocular lens library in the Indian scenario. Indian J Ophthalmol 2018; 66:1227-1228. [PMID: 30038193 PMCID: PMC6080443 DOI: 10.4103/ijo.ijo_634_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gunjan Saluja
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Esha Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sudarshan Khokhar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Malhotra S, Vashist P, Gupta N, Kalaivani M, Rath R, Gupta SK. Prevalence and causes of visual impairment among adults aged 15-49 years in a rural area of north India - A population-based study. Indian J Ophthalmol 2018; 66:951-956. [PMID: 29941738 PMCID: PMC6032730 DOI: 10.4103/ijo.ijo_1333_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: Very few studies have been conducted in India and other parts of the world on visual impairment among individuals aged 15–49 years. This study was conducted to determine the prevalence, causes, and associated factors of visual impairment among adults aged 15–49 years in a rural population of Jhajjar district, Haryana, north India. Methods: A population-based cross-sectional study was conducted in two blocks of Jhajjar district. A total of 34 villages were selected using probability proportionate to size sampling method. Adults aged 15–49 years were selected using compact segment cluster sampling approach. As part of the house-to-house survey, presenting visual acuity using screening chart corresponding to five “E” 6/12 optotypes was measured along with collection of other demographic details. The optometrists performed detailed eye assessment including repeat measurement of visual acuity using retro-illuminated conventional logMAR tumbling “E” charts, torch light examination, and non-cycloplegic refraction at a clinic site within the village to ascertain visual impairment and its cause. Results: Of 5,470 enumerated adults, 5,117 (94%) completed all study procedures. The age- and sex-adjusted prevalence of visual impairment was found to be 1.85% [95% confidence interval (CI): 1.48, 2.23] and blindness was 0.09% (95% CI: 0.01, 0.18). The age- and sex-adjusted prevalence of unilateral visual impairment was 1.11% (95% CI: 0.81, 1.41). Uncorrected refractive errors (84%) contributed maximum to visual impairment in this age group. The visual impairment in study participants was found to be associated with age and educational status. Conclusion: At the community level, uncorrected refractive errors contribute largely to visual impairment in the age group of 15–49 years.
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Affiliation(s)
- Sumit Malhotra
- Centre for Community Medicine, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Praveen Vashist
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Noopur Gupta
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramashankar Rath
- Centre for Community Medicine, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
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Amritanand A, Jasper S, Paul P, Kuriakose T. Facilitating factors in overcoming barriers to cataract surgical services among the bilaterally cataract blind in Southern India: A cross-sectional study. Indian J Ophthalmol 2018; 66:963-968. [PMID: 29941740 PMCID: PMC6032741 DOI: 10.4103/ijo.ijo_216_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To effectively address cataract blindness, increasing sight-restoring surgeries among the bilaterally blind are essential. To improve uptake of surgical services among this group, evidence regarding the problems of access is vital. Barriers in accessing eye care services have previously been reported but not specific to bilaterally cataract blind patients. Further, there is a gap in knowledge regarding factors facilitating access to eye care. Our aims were to (1) report proportion of bilaterally cataract blind patients undergoing surgery and sight restoration rate (SRR) and (2) analyze barriers and factors enabling access to eye care services among bilaterally cataract blind patients. Methods Retrospective analysis of interview and clinical data of bilaterally cataract blind patients undergoing surgery through outreach services at the base hospital, from June 2015 to May 2016, was performed. Demographic data, vision, postoperative visual outcomes, barriers, and facilitating factors in accessing cataract surgical services were obtained. Results Bilateral cataract blindness was present in 196/3178 (6.2%, 95% confidence interval 5.4-7.06) patients. SRR was 6.5%. Fear of surgery (24.2%) and lack of family support/escort (22.9%) were the most common barriers. Neighbors and acquaintances (28.6%), general health workers (20.2%), and persons who had undergone cataract surgery (19.6%) were the most common facilitating factors. Conclusion Proportion of bilaterally cataract blind people undergoing surgery and consequently SRR were low. The most common barriers were at the individual level while facilitating factors at the community level were instrumental in promoting uptake of services. Interventions involving community-based support for the blind may be useful in overcoming barriers to eye care.
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Affiliation(s)
- Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Padma Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Kuriakose
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
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Amritanand A, Paul P, Jasper S, Kumar SPV, Abraham V. Incorporating primary eye care into primary health care: Piloting a perceived visual disability questionnaire based model in rural southern India - An observational study. Indian J Ophthalmol 2018; 66:957-962. [PMID: 29941739 PMCID: PMC6032735 DOI: 10.4103/ijo.ijo_144_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: Over 20% of the world's visually impaired and blind populations live in India. Integration of primary eye care (PEC) into existing primary health care by trained personnel could address access-related barriers. We piloted an unreported, modified WHO disability questionnaire-based model for community health workers (CHWs) to screen and refer persons with perceived visual impairment instead of the traditional visual acuity model. The objective of the study was (1) to determine the prevalence of perceived visual impairment, rate of follow-up postreferral, distribution of ocular morbidity, visual impairment, and proportion of appropriate referrals and (2) to compare results of this intervention with those of existing services. Methods: CHWs were trained in administering a questionnaire for identification and referral of persons with perceived visual impairment in 7 rural villages and 22 tribal hamlets from the institutional database. In this cross-sectional study, patients screened and referred to PEC services from September 2014 to March 2015 underwent comprehensive ocular examination by an optometrist and ophthalmologist. Data collected from their records were analyzed retrospectively. Results: Of 18,534 individuals screened, 3082 (16.64%, 95% confidence interval: 16.06–17.14) complained of perceived visual impairment and were referred; 463 (15%) of these followed up for examination. Correct referrals were noted in 452 (97.6%) cases. Cataract (52.3%) and refractive error (15.8%) were the most common morbidities. There was a 39.6% increase in uptake of eye care services from baseline. Conclusion: The questionnaire-based screening tool administered by CHWs can lead to appropriate identification and referral of persons with ocular morbidity impacting uptake of eye care services.
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Affiliation(s)
- Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Padma Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vinod Abraham
- Community Health, Christian Medical College, Vellore, Tamil Nadu, India
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Chew FLM, Salowi MA, Mustari Z, Husni MA, Hussein E, Adnan TH, Ngah NF, Limburg H, Goh PP. Estimates of visual impairment and its causes from the National Eye Survey in Malaysia (NESII). PLoS One 2018; 13:e0198799. [PMID: 29944677 PMCID: PMC6019397 DOI: 10.1371/journal.pone.0198799] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 05/26/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Population-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique. METHODS Malaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling 'E' Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed. RESULTS A total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0-1.4%), 1.0% (95%CI: 0.8-1.2%) and 5.9% (5.3-6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively. CONCLUSION Increased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.
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Affiliation(s)
- Fiona L. M. Chew
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Mohamad Aziz Salowi
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Zuraidah Mustari
- Department of Ophthalmology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Mohd Aziz Husni
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Elias Hussein
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Tassha Hilda Adnan
- Clinical Research Centre, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Nor Fariza Ngah
- Department of Ophthalmology, Hospital Shah Alam, Shah Alam, Selangor, Malaysia
| | - Hans Limburg
- Health Information Services, Grootebroek, The Netherlands
| | - Pik-Pin Goh
- Clinical Research Centre, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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Biswas P, Gogate PM, Maskati QB, Natarajan S, Verma L, Bansal PK. Residency Evaluation and Adherence Design Study III: Ophthalmology residency training in India: Then and now-Improving with time? Indian J Ophthalmol 2018; 66:785-792. [PMID: 29785984 PMCID: PMC5989498 DOI: 10.4103/ijo.ijo_108_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/18/2017] [Indexed: 02/05/2023] Open
Abstract
Purpose To gauge the differences in ophthalmology residency training, academic, clinical and surgical, in the last three decades of the 20th century and the first decade of the 21st century. Methods A survey was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2014-2016, using a prevalidated questionnaire, which was circulated to ophthalmologists to gauge the practicality of the teaching protocols of clinical and surgical skills during postgraduate residency program. Results Of the 1005 respondents, 320 ophthalmologists who completed residency between 1967 and 2002 (20th century trained) and 531 who completed a residency in 2003-2012 (21st century trained) fulfilled the inclusion criteria. The average age was 49.2 years (standard deviation [SD] 4) and 32.6 years (SD 4), respectively. Twenty-first century trained ophthalmologists rated their training significantly better than the 20th century trained ophthalmologists for slit lamp examination (P = 0.001), indirect ophthalmoscopy, gonioscopy, automated perimetry, optical coherence tomography, and fundus photography (all having P < 0.001), while the 20th century trained rated their teaching of refraction, synoptophore, diplopia charting better (all P < 0.001). The range of grading was 0-10 in all categories. The median number of surgeries performed independently by 20th century and 21st century trained (during their training period) were: intracapsular cataract extraction (ICCE) 10, 0; extracapsular cataract extraction (ECCE) 43, 18; small incision cataract surgery (SICS) 5, 55; phacoemulsification (Phaco) 0, 1; pterygium excision 20, 15; dacryocystectomy 11, 4; dacryocystorhinostomy 11, 2; chalazion 35, 30; trabeculectomies 5, 0; strabismus correction 0, 0; vitrectomy 0, 0; keratoplasty 0, 0; eyelid surgery 6, 2; and ocular emergencies 18, 20. Conclusion Teaching of many clinical skills had improved over decades. Cataract surgery training has shifted from ICCE and ECCE to SICS and Phaco, but other surgeries were still taught sparingly. There was an enormous variation across the country in residency training which needs immediate attention.
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Affiliation(s)
- Partha Biswas
- All India Ophthalmology Society, New Delhi
- B B Eye Foundation, Kolkata, West Bengal, India
| | - Parikshit Madhav Gogate
- All India Ophthalmology Society, New Delhi
- Department of Ophthalmology, Dr. D. Y. Patil Medical College, Pimpri, Pune, India
- Dr. Gogate's Eye Clinic, Pune, India
| | | | - Sundaram Natarajan
- All India Ophthalmology Society, New Delhi
- Aditya Jyot Eye Hospital, Mumbai, India
| | - Lalit Verma
- All India Ophthalmology Society, New Delhi
- Centre for Sight, New Delhi, India
| | - Payal K Bansal
- Medical Education Technology Cell, Maharashtra University of Health Sciences, Nasik, Maharashtra, India
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Malhotra S, Vashist P, Kalaivani M, Gupta N, Senjam SS, Rath R, Gupta SK. Prevalence and causes of visual impairment amongst older adults in a rural area of North India: a cross-sectional study. BMJ Open 2018; 8:e018894. [PMID: 29550774 PMCID: PMC5875657 DOI: 10.1136/bmjopen-2017-018894] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To determine the prevalence, causes and associated factors for visual impairment (VI) in rural population of Jhajjar district, Haryana, north India. METHODS A community-based, cross-sectional study was conducted in two blocks of Jhajjar district. A total of 34 villages were selected using probability proportionate to size sampling method. Adults aged 50 years and above were selected using compact segment cluster sampling approach. Presenting visual acuity using LogMAR E chart was measured along with collection of other demographic details as part of the house-to-house survey. Subjective refraction and torch light examination were performed at a clinic site within the village to ascertain VI and its cause. VI was considered when presenting visual acuity was less than 6/18 in the better eye. Common causes of VI viz uncorrected refractive errors, cataract, central corneal opacity and others were noted by optometrists. Descriptive analysis was undertaken. Multivariate logistic regression analysis was performed for determining associated factors with VI. RESULTS Out of 2025 enumerated adults, 1690 (83.5%) were examined at the household level and 1575 (78%) completed all study procedures. The prevalence of VI was found to be 24.5% (95% CI 21.1 to 26.3) and blindness was 5% (95% CI 3.9 to 6.1). The most common causes of VI were uncorrected refractive errors (50%) and cataract (37%). The VI in study participants was found to be associated with age, gender, marital and educational status. CONCLUSIONS VI is still a public health problem in rural population of Jhajjar district, Haryana. Provision of spectacles and cataract surgical services are simple interventions to address this issue.
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Affiliation(s)
- Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Vashist
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suraj Singh Senjam
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ramashankar Rath
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Wadhwani M, Vashist P, Singh SS, Gupta N, Malhotra S, Gupta A, Shukla P, Bhardwaj A, Gupta V. Diabetic retinopathy screening programme utilising non-mydriatic fundus imaging in slum populations of New Delhi, India. Trop Med Int Health 2018; 23:405-414. [PMID: 29430785 DOI: 10.1111/tmi.13039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To develop and implement a community-based programme for screening of diabetic retinopathy (DR) in urban populations of Delhi. METHODS Known diabetics (KDs) aged 40 years and older were identified through house-to-house surveys, volunteers and publicity. All KDs were referred to DR screening camps organised locally where procedures included brief medical history, ocular examination and non-mydriatic fundus photography using portable handheld camera. Fundal images were graded on the spot by trained optometrists for DR. Patients with DR were referred to tertiary centre for management. RESULTS A total of 11 566 KDs were identified, of whom 9435 (81.6%) visited DR screening camps and 8432 (89.4%) had DR gradable images. DR was identified in 13.5% of subjects; 351 cases were mild NPDR, 567 moderate, 92 severe. Seventy-seven had PDR, and 49 had DME, and 2.7% of participants were blind (presenting visual acuity <3/60 in better eye). Non-use of lifestyle management, presence of systemic complications, BMI <18.5 kg/m2 , disease duration of >5 years and uncontrolled diabetes were associated with increased odds of DR. All cases with DR were referred, and 420 (37%) successful referrals to base hospital were observed. CONCLUSION The programme of creating awareness about DR, identifying KDs and optometrist-led DR screening using non-mydriatic fundus camera based in slums was successful.
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Affiliation(s)
- Meenakshi Wadhwani
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Praveen Vashist
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Suraj Senjam Singh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Noopur Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Sumit Malhotra
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Aparna Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Pallavi Shukla
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Amit Bhardwaj
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Vivek Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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